APIs May Boost EHR Optimization, Pediatric Care Functionalities

Application programming interfaces (APIs) and web services can help optimize EHRs for pediatric use, according to a recent policy statement published in Pediatrics, the official journal of the American Academy of Pediatrics (AAP).

Currently, many EHR systems lack pediatric features such as growth charts, anthropometric percentiles, weight-based dosing, and well-child visit and immunization schedule tracking.  

Additionally, it can be challenging for EHR vendors to stay up-to-date with clinical content, as agencies continuously put out new pediatric policies and guidelines. For instance, in August of 2017, AAP made significant changes to high blood pressure screening and management guidelines.

Implementing such changes directly in the EHR requires functionality development investment. Often, vendors will leverage content development tools to integrate pediatric functionalities into the EHR, but each individual customer must pay for the service.

APIs and web services may be a more cost-efficient route to EHR optimization, AAP suggested, as they provide solutions that can be shared across multiple EHRs and settings.

“Because Web services are smaller, more specialized software modules compared with EHRs, they have the advantage that they are easier to develop, test, and augment in a more rapid development cycle and do not have to rely on vendors to prioritize functions for development,” the report authors wrote.

When developing and implementing these services, stakeholders should ensure that the application is dependable, the authors noted.

“The use of a Web service or Web application introduces an external dependency, which needs to be reliable,” they explained. “Vendors must ensure that EHRs fail gracefully when the Web service or Web application is unavailable and allow users to complete their tasks.”

Next, the report called for developers to rigorously test the accuracy of their tools to ensure that the service functions properly and records the data used to generate calculations or guide clinical decision support. 

The report highlighted that as new versions of these tools are developed, a versioning history should be in place so that end-users are aware of changes.

“EHR vendors that integrate Web services and Web applications should actively communicate and be transparent with users about any changes in the content or delivery of these tools,” the authors recommended.

“For example, vendors should inform users when an integrated Web service or application has been updated and allow end-users the opportunity to steward Web services by providing feedback to mitigate any issues with accuracy,” they continued.

To optimize services for use in pediatric care settings, developers should engage directly with pediatric subject matter experts throughout the development and testing process, the authors said.

AAP recommended that developers and EHR vendors provide end-users with a “show your work” functionality that allows providers to understand the underlying algorithms that power clinical decision support.

Additionally, before going live, end-users should have an opportunity to test the system using realistic patient data, the authors noted.

New tools should comply with technical and terminology standards related to medical vocabularies, data structure, and data exchange, the authors explained. Additionally, the tools must ensure patient data privacy and security in compliance with all relevant Health Insurance Portability and Accountability Act regulations, they said.

Lastly, developers should support continued maintenance to stay up-to-date with new clinical guidelines and standards, the authors explained.